At the Overdose Prevention Society

The fentanyl crisis in British Columbia continues unabated. There were 128 overdose deaths in November, the worst month on record until December’s figures were released this week: 142 deaths. There were nine fatal overdoses in Vancouver on the night of 15 December alone. Last year, 914 people died in the province from illicit drug overdoses, an increase of 80 per cent on the previous year. (The problem isn’t restricted to Canada. According to the Centers for Disease Control and Prevention, ‘the death rate of synthetic opioids other than methadone, which includes drugs such as tramadol and fentanyl, increased by 72.2 per cent’ in the United States between 2014 and 2015. In 2013, more than 2000 people died from opiate overdose in the UK.)

In early December, British Columbia’s provincial health minister, Terry Lake, announced the establishment of a mobile medical unit in the Downtown East Side Area, which has the highest number of intravenous drug users in Vancouver. Overdose patients can be treated there on site, rather than having to be transported across town to the already overburdened ER. Two new safe injections sites have also opened.

A week before Christmas, I revisited the pop-up safe injection tent (now known as the Overdose Prevention Society) set up by Sarah Blyth and Ann Livingston in September. They’d added a second tent at the original site and a further tent had been set up at another alley (since taken down because the new indoor safe injection site at 177 East Hastings Street is located right there). The atmosphere was welcoming and there was a steady influx of people. The volunteer, a part-time librarian, said they were encouraging people to sit longer so that if they went down they could be helped and given naloxone (which reverses the effects of opioids). It costs as little as $150 a day to run. An online crowdfunding campaign raised $27,000.

The following day a local business donated a trailer to the Overdose Prevention Society and Vancouver Coastal Health gave them three months’ funding. I visited the new trailer one Thursday lunchtime earlier this month. It is a warm, dry, clean space, larger than I had expected. It has eight tables with room for two people to shoot up at each. Power came in on an extension cord from the street market. A volunteer was recording on a clipboard what each person is injecting.

Some clients said they preferred the plastic tables in the old tent, which were easier to put your legs under, but the stainless steel tables in the trailer can accommodate more people and are easier to clean.

Nearby there was a tent and another shelter, with no door, where people were smoking (cigarettes, crack or meth). This ‘low barrier’ approach is designed to encourage people to stay long enough to be looked after if they overdose. It saves lives. That morning there had been three overdoses, Blyth said. Everyone survived. Staff can also help users access rehab and other services when they are willing and ready to do so.

The work of these dedicated activists is helping people and saving lives, but it isn’t a long-term solution to the public health emergency. The street drug supply is contaminated not only with illicit fentanyl but also carfentanil, which is 10,000 times more potent than morphine (it’s used to tranquilise elephants).

Campaigners are demanding that addiction be decriminalised and chronic users given immediate access to safe heroin. Last September, the Liberal government revoked the Conservative ban on doctors prescribing diacetylmorphine (pharmaceutical grade heroin) to addicts. But just because it’s legally possible doesn’t mean it’s happening. Doctors still have to apply to Health Canada for access to diacetylmorphine; they also need training. Blyth told me that it’s extremely difficult, if not impossible, for users to find someone to prescribe it.

Effective harm reduction requires committed, practical, financial action, however politically awkward it may be – not blathering that 'more needs to be done' while failing to create the active means to do it. It has been suggested, even by members of Justin Trudeau's own party, that because the population most effected by the crisis is way out on the West Coast rather than by his shins in Ontario, the prime minister doesn’t care. Alberta is even more scuppered than BC. A provincial public health emergency hasn’t even been declared and there are no safe injection sites at present.

The Providence Crosstown Clinic in Vancouver has been providing heroin to a small number of patients since December 2011, as part of a clinical study to assess long-term opioid maintenance effectiveness. It found that ‘diacetylmorphine is more effective than oral methadone for some of the most vulnerable heroin users.’ But it also found that hydromorphone, a legal, licensed pain medication is ‘as good as diacetylmorphine and should now become an alternative for those currently not benefitting from methadone and other treatments, and be integrated in the treatment continuum available through licensed doctors’.

I asked a few of the people using the Overdose Prevention Society’s facilities what difference a daily supply of legal, medical-grade heroin would make to them. One man indicated a pair of trainers, label intact, sitting on the table: ‘I wouldn’t have to go shopping,’ he said. A young woman struggling to find a vein said she had been on a waiting list for three years. A man in his thirties told me he’d once been a homeowner and businessman. Now he lived on the streets. You can’t hold a job if you are an addict, he said. The older man sitting next to him said that wasn’t true: he worked full time in construction. If he had access to medical grade heroin, he said, rather than having scavenge about to score drugs from unreliable sources, he would be able to lead a much more functional life.

The youngest person I stood and nattered with told me he’d once overdosed three times in one day but now shot up smaller amounts. How many times had he shot up that day? ‘About 15.’ He was eating trail mix with one hand and offering to share it with others. He took his 16th shot of the day while I was talking to him. ‘I am after the rush,’ he said quietly. How long had he been injecting? Fifteen years, since he was 12. I asked him where grew up. He named a Canadian city and swiftly added ‘foster care’. He was in and out of group homes throughout his childhood. I asked him what the rush felt like. ‘A warm blanket,’ he said.